Depression During Pregnancy

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Depression During Pregnancy

• Kathleen S. Peindl, M.S., Ph.D.
• Associate Professor in Psychiatry
• Thomas Jefferson University
• Philadelphia, PA 19107

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Over the past 18 years, my interest in prenatal
depression grew for two reasons. First, it has
become increasingly clear that prenatal
depression is a risk factor for recurrent
depression throughout the female life cycle.
Second, both prenatal and postpartum depression
adversely affect child development. Breaking the
cycle of depression through identification,
education and treatment is one of my goals.
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Depression During Pregnancy Learning Objectives

• To understand what prenatal depression is
• To learn about a tool for depression screening
• To understand some consequences of the illness
• To learn about treatments of depression during
  pregnancy

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Performance ObjectivesDepression During Pregnancy

• To be able to recognize depression during
  pregnancy
• To know the risk factors for depression during
  pregnancy
• To know some cost of the illness to the mother
  and infant
• To understand treatments for the disease

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Depression Onset in Young Adult Women

• Depression in females is 2 times higher than the
  rate found in males
• Change in rates occurs during puberty and the
  onset of menses

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Young Women and Depression

• Women, aged 22, with major depressive disorder
  had first onset of illness in adolescence
• 44 had their first episode of major depression
  during pregnancy

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What is Depression During Pregnancy

• Diagnosis
• Symptoms
• Difficulty with Diagnosis
• Prevalence Rates of Detection of Illness

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Diagnosis of Depression

• Most Mental Health Professionals use DSM-IV
  criteria as the standard to diagnose Psychiatric
  Disorders
• The Prime-MD is used in general clinical settings
  to diagnose common psychiatric disorders and will
  code the disease using DSM-IV Criteria

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Symptoms of Depression and of Normal Pregnancy

• Pregnancy
• Sleep Disturbances
• Weight Gain
• Appetite Disturbances
• Fatigue

• Depression
• Sadness
• Loss of interest
• Sleep disturbances
• Weight loss/gain
• Guilt/Worthlessness
• Thoughts of death
• Appetite disturbances
• Fatigue

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Difficulty with Diagnosis of Illness

• 50 of women have undiagnosed depression in an
  obstetric/gynecology clinic
• The rate of detection may be as low as 0.8 among
  pregnant women

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Prevalence of Depression During Pregnancy

• Assessments method for determining prevalence
  rates of depression during pregnancy fall into
  three categories
• Self-reported symptoms
• Distress
• Structured psychiatric interviews using Standard
  Diagnostic Criteria
• Real Prevalence worldwide is around 10 in
  pregnant adult women

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Valid Tool for Screening for depression during
pregnancy

• A Tool for screening must access only affective
  and cognitive symptoms
• Edinburgh Postnatal Depression Scale

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Recognition of Depression During Pregnancy

• Awareness of depression during pregnancy starts
  with screening. On the Edinburgh Postnatal
  Depression Scale, the score would be gt10.

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Risk Factors for Depression During Pregnancy

• Race and Ethnicity increased rates among
  African-American and Hispanic populations
• Adolescents
• Single status
• Low Socio-economic status (world-wide risk
  factor)
• Uninsured status
• Personal History of Depression
• Family History of Depression

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Consequences of Depression During Pregnancy

• Two sets of consequences need to be identified
  for depression during pregnancy
• A. Those affecting the mother
• B. Those affecting the fetus

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Depression and the Mother

• Women with Prenatal Depression have
• Poor prenatal care and health behaviors
• Poor weight gain and nutrition
• Fatigue and loss of functioning
• Disturbed sleep
• Use of drugs including cigarettes and illicit
  drugs

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Prenatal Depressive Symptoms and Fetal
Development

• Increase in Preterm Delivery
• Mean gestational age 29.5 weeks
• Reduction in birth weight of 9.1 grams for every
  one point increase in a self-report measure of
  depression in low-SES group
• 4-fold increase in low birth weight babies in an
  African-American population

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More Childhood Outcomes

• At birth the risk of unconsolability is 2.64
• High Scores on the Childhood Behavioral Checklist
  for Externalizing for children whose mothers had
  prenatal depression

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Treatment of Depression During Pregnancy

• Experts differ on optimal treatment

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Risk Benefit Ratio

• Discontinuation of treatment before conception
• Continuation of Treatment until conception
• Treatment if illness severe maintain through
  pregnancy

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Exposure of Psychotropic Medication to Fetal Brain

• Morphological teratogenesis
• Behavioral teratogenesis

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Morphological Teratogenesis

• Embryonic Period weeks 2-8
• Fetal Period (months 4-9)

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Behavioral Teratogenesis

• Little is known about effects of medication
  treatment for prenatal depression
• Depressive symptoms do adversely effect
  behavioral outcomes in offspring

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FDA Classification for Antidepressants use during
pregnancy

• Antidepressant medication used to treat depression

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FDA Category A

• Controlled studies show no risk
• No Antidepressants are Category A

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FDA Category B

• Inadequate number of human studies, animal
  findings are negative
• Animal studies show risk but human studies do not
  show risk
• Bupropion is category B

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FDA Category C

• Risk cannot be ruled out. Human studies are
  lacking.
• Animal studies show risk or there are few animal
  studies completed.
• Following list are category C

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FDA Category D

• Negative risk to the fetus
• No Antidepressants in this category

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FDA Category X

• Contraindication for Pregnancy
• Fetal Risk outweighs benefits

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Successful Treatment

• Successful Treatment also found with Therapy
  Interpersonal Psychotherapy
• No risk of exposure to the fetus